Abstract
BackgroundDifferentiating between bipolar spectrum disorder (BD) and attention deficit hyperactivity disorder (ADHD) in childhood and adolescence is difficult because the clinical presentation is influenced by ongoing neural development, causing considerable symptom overlap. Motor problems and neurological soft signs have been associated with ADHD for decades. Little is known about motor skills in BD. Here we assess the diagnostic accuracy of neuromotor deviations in differentiating ADHD from BD in clinical practice. We also investigate if these deviations exist in concurrent ADHD and BD, thus indicating true comorbidityMethods64 patients 6-18 years (31 girls, 33 boys) fulfilling the diagnostic criteria of BD, ADHD combined subtype (ADHD-C) or comorbid BD and ADHD-C, were compared using an age-standardized neuromotor test; NUBU. Categorical variables were analyzed using cross table with two-tailed chi square test or Fisher's exact test when appropriate. Continuous variables were analyzed by Kruskal-Wallis test and, if significant, Mann-Whitney U test and ROC plots.ResultsThe ADHD-C group and the comorbid ADHD-C and BD group both showed significantly more neurological soft signs (p less than 0.01) and lower mean static coordination percentile (p less than 0.01) than the BD group. The positive predictive value of NUBU in the diagnosis of ADHD-C with or without concurrent BD was 89% (80-95) for total soft signs and 87% (79-95) for static coordination below the 7.5 percentile.ConclusionAn age-standardized neuromotor test battery may promote diagnostic accuracy in differentiating ADHD from BD in clinical practice, and help evaluating whether symptoms of ADHD in children who have BD reflect symptom overlap or real comorbidity. This may have important implications for everyday diagnostic work.
Highlights
Differentiating between bipolar spectrum disorder (BD) and attention deficit hyperactivity disorder (ADHD) in childhood and adolescence is difficult because the clinical presentation is influenced by ongoing neural development, causing considerable symptom overlap
Attention deficits are often found in BD [2] and affective episodes are common in ADHD [3]; manic symptoms in children may be a marker of severe psychopathology rather than of a specific diagnosis [4]
BD was defined as Bipolar disorder I (BP-I) or Bipolar disorder II (BP-II) according to Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) [32], or Bipolar spectrum disorder not other specified (BP-NOS) according to the Course of Bipolar Youth criteria [33]: "A minimum of elated mood plus 2 associated DSM-IV symptoms, or irritable mood
Summary
Differentiating between bipolar spectrum disorder (BD) and attention deficit hyperactivity disorder (ADHD) in childhood and adolescence is difficult because the clinical presentation is influenced by ongoing neural development, causing considerable symptom overlap. Attention deficits are often found in BD [2] and affective episodes are common in ADHD [3]; manic symptoms in children may be a marker of severe psychopathology rather than of a specific diagnosis [4]. Neuroimaging studies indicate biological differences between the disorders [5], but these methods are not useful in clinical practice. It is a need for clinical useful signs to support our descriptive diagnoses
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